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Chacruna.net is a hub for producing and disseminating high-quality multimedia content about plant medicines and psychedelics, facilitating access to these resources online. The website’s central objective is to offer content created and curated by leading experts in the field, edited to a wider audience. The field of psychedelics is filled with misinformation, anecdotal narratives, poorly trained professionals and enthusiasts with no field experience, leading discussions with large audiences of novices to the subject.

Ismail L. Ali, JD, currently works as Policy & Advocacy Counsel for the Multidisciplinary Association for Psychedelic Studies (MAPS), presently serves as Chair of the Students for Sensible Drug Policy Board of Directors, and is licensed to practice law in the state of California.

Is Medicalization the Only Way to Legalize Psilocybin and Ibogaine?

Ismail L. Ali, JD, currently works as Policy & Advocacy Counsel for the Multidisciplinary Association for Psychedelic Studies (MAPS), presently serves as Chair of the Students for Sensible Drug Policy Board of Directors, and is licensed to practice law in the state of California.

Legalizing Psychedelics
for Therapeutic Use is the First Step in a Long Road.

In
the United States, the Food and Drug Administration (FDA) and Drug Enforcement
Administration (DEA) regulate and enforce how drugs are researched, marketed,
sold, and, in some cases, criminalized. The scheduling framework and varying
levels of control over these substances, implemented by FDA and DEA, is
apparently based on the substances’ safety for humans, medical value (or lack
thereof), and abuse potential. Despite the fact that paltry scientific evidence
was presented or sought to justify their criminalization when psychedelic
substances were originally outlawed, the only way, besides Congressional
intervention, to take them out of Schedule I—the most restrictive category—is
to prove to the FDA that they are, in fact, safe for humans to take, have
medical value, and are not as prone to abuse as originally asserted.

However,
scientifically proving these claims relies on a narrow definition of medical
value, and onerous, expensive regulatory requirements. Despite these obstacles,
scientists, researchers, and therapists have made heroic efforts over the last
few decades to produce sufficient scientific evidence to satisfy the FDA that some
substances, like MDMA and psilocybin, are safe and have a demonstrated medical
benefit.

the effort to destigmatize and legalize psychedelic substances via medicalization is a deliberate and strategic response to the original, flawed justification behind criminalization

In
other words, the effort to destigmatize and legalize psychedelic substances via
medicalization is a deliberate and strategic response to the original, flawed
justification behind criminalization.

As a
result, it is no surprise that medicalization dominates discussions about legal
access at this time, and that it is the most visible portal thorough which organizations
like MAPS and others have worked toward reviving cultural respect for
psychedelic substances in the United States. Medicalization has some clear
benefits. A medicalized scheme theoretically promises consistency in quality of
product, reliability of service and care, and assurance of accountability in case
of malpractice. There is no doubt a plethora of new scientific and medical uses
for psychedelic substances that remain to be discovered.

That
said, medicalization also comes at a cost, literally. The US healthcare system
is unjustly inaccessible and unconscionably expensive. While state-legal cannabis
flower now costs as little as $100 per ounce in some legal states, the FDA-approved
GW Pharmaceuticals CBD-based epilepsy treatment, Epidiolex, is expected to cost $32,500 per year.

Federal
medicalization of psychedelics has complicated implications, opportunities, and
baggage. Although it is strategically sound, it is not the only route toward
legal access, and there is an increasing interest in exploring other options,
like citizen-led initiatives or legislation. These options have different
costs, risks, and opportunities.

Cannabis Can Inform Where
We Start, but It Can’t Show Us Where to Go.

In
contemplating options for the future of legal access to psychedelic substances,
the ever-evolving landscape of cannabis policy serves both as inspiration and
as a warning. In the 1980s, cannabis advocates recognized that Congress was not
going to reschedule cannabis anytime soon, and they weren’t wrong; although we
are closer to rescheduling than ever, it hasn’t happened yet. At
the time, seeking FDA approval for cannabis as a medicine by clinically proving
the safety, medical value, and lower-than-claimed abuse potential of cannabis
was also not a viable possibility. So, other options had to be explored and, in
1996, California passed Proposition 215, a citizen-led initiative that created
a state-sanctioned medical cannabis scheme that operated as an alternative to
the medical system as regulated by the FDA. Twenty years later, in 2016,
California passed Proposition 64, another citizen-led initiative that legalized
cannabis for adult use.

Legalizing and regulating cannabis independently
of the federal government is a significant step forward, but it has had its limitations.
Bringing the cannabis economy out from the underground has come with growing
pains and wake-up calls:
bureaucracies tend to be clumsy and, perhaps predictably, corporations have
begun to take over the market. There is ongoing confusion about how to tax,
regulate, and license cannabis under different schemes, and frameworks for
state-regulated medical use of cannabis and other non-medical, adult-use or
“recreational” schemes sometimes
conflict under inconsistent or
unclear standards and regulations.

That said, state-regulated cannabis systems have
also modeled some helpful fundamentals for legal access: protection from
criminal penalties for growing and using cannabis; access through home
cultivation, cooperatives, or dispensaries; and availability of a variety
of strains and methods of ingestion. Although the complications are real, a
diversity of experience is theoretically respected and protected.

However, things are different now than they were 30 years ago, and today’s efforts must be analyzed based on today’s context.

Given this history, an optimistic observer could
conclude that state-by-state, non-federally-approved medical or adult-use
regulation of psychedelic substances is a viable option. However, things are
different now than they were 30 years ago, and today’s efforts must be analyzed
based on today’s context.

Is it too cynical to say that in a capitalist economy, legalization essentially means “permission to commodify”? Photo credit: Reuters/Jerry Lampen

Efforts to Legalize and Regulate Psychedelics Must
be Substantive and Strategic.

In the last few years, advocates in California, Oregon, and the city of Denver, Colorado have been making efforts to decriminalize or regulate psilocybin mushrooms through citizen-led initiatives

In the
last few years, advocates in California, Oregon, and the city of Denver,
Colorado have been making efforts to decriminalize or regulate psilocybin
mushrooms through citizen-led initiatives. These efforts seem to offer an
alternative to the federal medicalization of psilocybin, a prospect which has
fostered ongoing dialogue about what a post-prohibition world ought to look
like.

The California Psilocybin Legalization
Initiative
was a bare-bones attempt to decriminalize psilocybin use, possession,
cultivation, sale, and transportation in California, which did not qualify to
appear on the ballot in California after failing to get enough signatures in
early 2018. Despite the potential for historic progress in my home state of
California, serious concerns about CPLI’s leadership and strategy led some
advocates, including me, to breathe a sigh of relief.

On
another end of the spectrum, the complicated and crowded Oregon 2020 Psilocybin Service Initiative, initiated by the Oregon
Psychedelic Society, will attempt to decriminalize psilocybin possession in
Oregon, define a community-based service and regulatory framework, and create
licensing and enforcement mechanisms under the Oregon Health Authority in order
to allow access to guided psilocybin experiences.

Finally,
the Denver for Psilocybin campaign is presently seeking signatures to its initiative
to decriminalize the use, possession, and cultivation of mushrooms containing
psilocybin (or psilocin, baeocystin, and nor-baeocystin) onto Denver’s May 2019
ballot. Decriminalization of any kind, even at a local level, would undoubtedly
be a significant step toward a more equitable drug policy; however, it is also exactly
the kind of progress that is likely to get immediate unfavorable attention from
the federal government.

Ultimately,
initiatives like these require significant financial and human resources; how
do we know when it makes sense to fund and support them? Specific polling, a
cohesive legal strategy, and experienced leadership, not to mention large-scale
community organizing, would all go a long way to make psilocybin decriminalization
a reasonable possibility in the near future. However, the threat of a backlash
from failure, poor or reckless strategy, or political shortsightedness could
cause harm to future efforts and the movement as a whole. We should proceed
bravely, but with caution.

In
the last few years, bipartisan legislators in Vermont (H 741), New York (AB 5449), and Maryland (HB 1207) have
also proposed legislation to tackle the overdose crisis by funding pilot
programs or research into the clinical use of ibogaine for opioid use disorder.
HB 1207 in Maryland was discussed once again this year, but has stalled once
again.

These
programs have been informed by some scientific evidence (and decades of extensive
anecdotal reports) of ibogaine’s efficacy in interrupting opioid withdrawal. Reports
about ibogaine’s efficacy have reached lawmakers in a variety of ways,
including, in some cases, through hearing about experiences of the children of
their peers. This is undoubtedly evidence of how widely the impact of the overdose
epidemic has spread, and perhaps also how the demographic and racial realities or
perceptions of the crisis impact the government’s response.

These
efforts to legalize at the state level, all of which follow a biomedical model
of research and clinical treatment, have unfortunately stagnated. The
legislative process, especially in today’s political climate, is inconsistent
and unreliable… so can we afford to keep waiting for our representatives to
make the right decisions on our behalf?

The “new era of psychedelic policy” that we are in offers many questions, and few clear answers. Knowing what we now know about cannabis legalization and the industry that is being built around it, it is challenging to justify policies that create exceptions for the legal use of some drugs while continuing to accept the on going criminalization of others. To that end, efforts to create legal access must be informed by efforts to fully decriminalize all drugs. This would mean completely abolishing criminal penalties for any use of any drug, which would encompass a complete reduction of punitive consequences for the use of psychedelics.

And although the legal and practical viability of the psilocybin initiatives themselves remain in question, efforts to decriminalize psilocybin are certainly starting a conversation which is long overdue.

That
said, policy change is slow by design, and incremental progress is still
progress. Especially given the unlikely possibility of progressive Congressional
intervention in drug policy, state-level legislative interest in ibogaine is
encouraging, and it signals a willingness to step out of the box that may only
be possible in part because of advances in scientific research. And although the
legal and practical viability of the psilocybin initiatives themselves remain
in question, efforts to decriminalize psilocybin are certainly starting a
conversation which is long overdue.

As
with cannabis, it is true that psychedelic substances legalized or
decriminalized under state law would remain illegal under the federal
Controlled Substances Act. While previous administrations have formally taken a
non-enforcement policy against well-regulated state-legal cannabis industries,
there is always a risk that current or future administrations may act more
punitively. Psychedelics do not have the same level of public support that cannabis
does (yet); in their
case, there is no
reason to believe that any changes in state or local law that violate federal
law would be respected by an unsympathetic Attorney General. As a result,
legislatures willing to challenge federal law are playing with fire, and
citizen-led initiatives are no more secure.

This
leads us to an inevitable conclusion: until we vote
in representatives
with progressive, evidence-based, compassionate drug policies, the process of
taking certain psychedelics through the FDA approval process grudgingly remains
the way to create legal access that is most protected from politically inconsistent
leadership.

Creating a Post-Prohibition
Future Requires That We Acknowledge Our Limitations and Learn as We Go.

Cannabis
legalization and progress in many movements outside of drug policy all have at
least one central theme: that the changes we are seeking in the law require
more than just new laws. They also require the support of a community that is stable
and resilient enough to responsibly steward the associated social, ideological,
and psychospiritual shifts in the status quo, especially in the face of
bureaucracies, corporations, and decades of drug hysteria.

It is
clear that this community support is growing, as more and more people recognize
the value of the responsible use of psychedelic substances. However, ensuring legal,
safe, and equitable access will require buy-in from people at every level of society
and government, from our strongest supporters to our most ardent skeptics. Although
the U.S. government’s institutions may not yet have the range to appreciate or even
understand the complete scope of how psychedelic substances can be utilized to
maximize our collective potential, and may continue attempting to fit octopus-shaped pegs into square holes, this people-powered
shift could do more than just lead to the decriminalization or rescheduling of
psychedelic substances; it could also fundamentally change how our society
approaches topics like healing, spirituality, and personal growth.

The process
by which we end the cruel and archaic criminalization of psychedelic substances—and
replace it with safe, legal, and equitable access—will set the tone for a
post-prohibition world. We should approach each of our steps forward in the
same way one should approach the psychedelic experience: with respect,
intention, and a willingness to learn as we go.

Note:

This paper was
presented at Cultural and Political Perspectives
in Psychedelic Science, a symposium
promoted by Chacruna and the East-West Psychology Program at the
California Institute of Integral Studies (CIIS), in San Francisco on
August 18 and 19, 2018. The author would like to acknowledge Rachelle Yeung and
Natalie Ginsberg for their feedback to this piece.

Help support Chacruna's team by being a sponsor

Chacruna.net is a hub for producing and disseminating high-quality multimedia content about plant medicines and psychedelics, facilitating access to these resources online. The website's central objective is to offer content created and curated by leading experts in the field, edited to a wider audience. The field of psychedelics is filled with misinformation, anecdotal narratives, poorly trained professionals and enthusiasts with no field experience, leading discussions with large audiences of novices to the subject.